Is Alzheimer's undertreated?

Although 95 percent of individuals with mild to moderate Alzheimer's take at least one medication for another health condition, only about 35 percent have ever been prescribed one of the standard drugs for early Alzheimer's, Mary Sano, Ph.D., and colleagues report in the current issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

The Alzheimer drugs are cholinesterase inhibitors, the only type currently approved by the U.S. Food and Drug Administration (FDA) to treat mild to moderate stages. A 2001 guideline on dementia treatment issued by the American Academy of Neurology recommended that cholinesterase inhibitors should routinely be considered for mild to moderate Alzheimer's. Three cholinesterase inhibitors are commonly used: donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon).

"It's worrisome that nearly two-thirds of those in this study never had the opportunity to try a cholinesterase inhibitor," says William H. Thies, Ph.D., Alzheimer's Association vice president, medical and scientific affairs. "We all know these drugs are not our final answer to Alzheimer's, but they are what we have to offer now. The fact that they're not being used raises a red flag about the general state of diagnosis and treatment, and whether people are receiving other aspects of disease management and support."

Cholinesterase inhibitors, on average, modestly delay worsening of symptoms for around six months to a year. Some clinicians believe a percentage of patients may temporarily benefit more dramatically.

Use of cholinesterase inhibitors varied by race. Slightly more than 60 percent of white participants had taken one at some time, compared with only 25 percent of those from other ethnic groups.

For this study, researchers recruited 2,114 individuals with mild to moderate Alzheimer's at 406 U.S. community medical practices. The goal was to assess how regularly participants took galantamine (Razadyne), one of the cholinesterase inhibitors, and vitamin E, when doctors prescribed these medications. The information obtained from participants and caregivers at the time of enrollment provides a "snapshot" of community dementia treatment. Other findings included the following:

Average participant age was about 78 years; 68 percent were women

Average caregiver age was 62; 70 percent were women

Nearly 65 percent of participants were diagnosed and about 60 percent were treated by their primary care physicians

On average, participants were taking five other medications, and 95 percent were taking at least one

About 46 percent of caregivers were spouses; 35 percent were sons or daughters; 13 percent were other relatives or friends; and 6 percent were paid professionals